Author Information

Ermengol Valles,

Victor Bazan,

Miguel Cainzos,

Begoña Benito,

Miguel Eduardo Jauregui,

Jordi Bruguera and

Julio Martí

Background

Achievement of complete conduction block across the cavotricuspid isthmus (CTI) is associated with a reduction in typical atrial flutter recurrences after ablative therapy. A <20 ms increase in the distance between the 2 CTI potentials during the Incremental Pacing (IP) maneuver has been proved as a highly specific marker to differentiate functional from complete CTI block during ablation.

Methods

One hundred and thirty-four patients (78% males; 67 ± 13 years) undergoing successful CTI ablation were included and separated into 2 groups as follows: Group 1 (n = 68), in whom ablation was performed before the incorporation of the IP maneuver; and Group 2 (n = 66), undergoing IP during ablation to corroborate complete CTI block. The completion of the CTI block was also assessed through other previously reported maneuvers in both groups.

Results

No differences between Group 1 and Group 2 were observed in relation to fluoroscopy or radiofrequency times (18 2 vs. 17 7 min and 873 380 vs. 825 426 sec, respectively, p > 0,05). As expected, the follow-up period was longer in Group 1 (1366 571 vs 588 228 days, p < 0,01). Flutter recurrences were observed in 12 patients (9%), essentially occurred during the first year after ablation (in 9/12 patients, 75%), and were more common among Group 1 patients (10/68 patients (15%) vs. 2/66 patients (3%); p = 0,039).

Conclusion

Utilization of the IP maneuver for the diagnosis of complete CTI block is accompanied by a reduction in atrial flutter recurrences after ablation.

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